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2012-01-31-11 Chorioangioma and persistent left superior vena cava © Cerekja www.TheFetus.net


Chorioangioma and persistent left superior vena cava


Albana Cerekja MD, PhD1; Francesco Cecinato2; Juan Piazze, MD, PhD3; Gabriele Masselli4.

1 Ultrasound Division, ASL Roma B, Rome, Italy;
2 Obstetrics Department. Umberto I Hospital, “La Sapienza” University, Rome, Italy;
3 Ultrasound Division, Ceprano Hospital, Ceprano, Italy;
4 Radiology Department, Umberto I Hospital, “La Sapienza” University, Rome, Italy.

(Edited by F. G.)

A placental chorioangioma is a benign vascular tumor (hamartoma) of placental origin. It is the most common tumor of the placenta, and is usually found incidentally.

Case report

A G1P0 woman was scanned for fetal growth evaluation at 31 weeks of pregnancy. Her previous ultrasonographic examinations performed elsewhere were reported to be normal.

A heterogeneous predominantly hyperechoic mass of 4 cm was seen inside the placental mass and not at the chorial plate level bulging in the amniotic cavity as usually occurs with chorioangiomas. It presented discrete vascularity. A vascular pedicle was seen showing fetal vessels waveform with a good diastolic component. Amniotic fluid volume was at lower limits for gestational age (AFI 12 cm), fetal growth was along 50 percentile but a high resistive index (0.78) with protodiastolic notch was seen in the right uterine artery. In the left side, resistances were normal (RI 0.37). Furthermore, a dilated coronary sinus was seen resulting from the drainage of a persistent left superior vena cava.

Three weeks later the patient was scanned again. Fetal growth curve declined (from 50 to 25 percentile), amniotic fluid volume was lower (AFI 10 cm).  Dimensions of the mass were the same, but vascularity looked richer. Doppler waveform was normal with high diastolic flow in the arterial vessels.

MCA PSV was 58 cm/sec that suggested no fetal anemia according to Mari curves.

The patient was referred to a tertiary level center.

A magnetic resonance was also performed at 36 weeks and confirmed the ultrasonographic findings.

A female neonate of 2700 grams and Apgar score 9/9 at 1/5 min was born spontaneously at 39 weeks. She presented 2 small hemangiomas, one on the mucosa of the upper lip and the other in the vulva. A magnetic resonance was asked to search for brain hemangiomas. Postnatal echocardiography confirmed coronary sinus dilation with persistence of the left superior vena cava. No other heart anomalies were seen and there were no signs of heart overload due to chorioangioma.

Pathology of placenta confirmed our hypothesis.

Ultrasonographic images and videos show the chorioangioma, its vascular supply, Doppler of the chorioangioma and fetal and maternal vessels, dilated coronary sinus and left superior vena cava.

Images 1, 2, 3, and 4: The images show inhomogeneous hyperechoic mass of the chorioangioma.

 

 

Images 5, 6, 7, 8, 9, and 10: The images show vascular supply of the chorioangioma.

 

 

 

Images 11, 12, and videos 1, 2: The images show dilated coronary sinus of the heart (image 11 and videos 1, 2) and persistent superior vena cava (image 12).

 

 

Image 13: An axial T2 Haste MR image shows the chorioangioma inside the placental mass.

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